| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,032 |
6,973 |
$195K |
| D1206 |
Topical application of fluoride varnish |
7,937 |
7,692 |
$193K |
| D0120 |
Periodic oral evaluation - established patient |
6,576 |
6,524 |
$155K |
| D1351 |
Sealant - per tooth |
3,473 |
984 |
$92K |
| D0272 |
Bitewings - two radiographic images |
3,688 |
3,662 |
$44K |
| D1999 |
|
4,011 |
3,872 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,135 |
1,067 |
$34K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
275 |
76 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
398 |
251 |
$31K |
| D1110 |
Prophylaxis - adult |
375 |
373 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
309 |
303 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
573 |
573 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
206 |
206 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,345 |
1,317 |
$8K |
| D0330 |
Panoramic radiographic image |
489 |
486 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
109 |
77 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
317 |
304 |
$2K |